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Thyroid Eye Disease

What is Thyroid Eye Disease?

Thyroid eye disease is an inflammatory condition that involves both the thyroid gland and the eye sockets (orbits). It occurs most often in patients who have Graves’ disease—an autoimmune disorder that results in the overproduction of thyroid hormones—although it can be caused by any type of thyroid disorder.

The condition causes the fat and muscles in the orbit to become enlarged, resulting in several symptoms, including bulging eyes, eyelid retraction, eye pain, double vision (diplopia), and in severe cases, vision loss.

Team-Oriented Care

The complex and potentially debilitating symptoms of thyroid eye disease require coordinated specialty care. Our Center for Thyroid Eye Disease and Orbital Surgery at Mass. Eye and Ear includes a multi-specialty group of doctors who can treat the full spectrum of thyroid eye disease symptoms. For instance, ear, nose, and throat specialists, along with orbital surgeons, may perform surgery to correct a bulging eye. Strabismus surgeons work closely with orbital surgeons to improve double vision and restore visual function, and eyelid surgeons improve eyelid function and appearance.

Minimally Invasive Surgery

Our surgeons have also pioneered minimally invasive surgical approaches for thyroid eye disease. Patients experience a shorter hospital stay, faster healing time, and less pain compared to traditional surgeries. Because these delicate, state-of-the-art surgeries are performed through the nose (instead of a large incision near the eye), there is also less scarring and a lower risk of infection.

For instance, endoscopic orbital decompression surgery is a minimally invasive procedure that is used in patients with bulging eyes. During the procedure, an ear, nose, and throat specialist removes some of the bones in the eye socket (orbital walls) to create more space for the enlarged muscles and fat that may be affecting vision. Depending on the severity of the eye disease, the surgery may also include decompression of the outer orbital wall, which is performed by one of our oculoplastic surgeons.

Because the surgery is performed entirely through the nostrils, the sinus cavities are removed and occasionally the nasal septum may need to be straightened to improve access. A possible side effect is double vision. However, our doctors have pioneered new techniques to minimize, and in some cases, avoid double vision after surgery.

The patient will have several post-surgery checkups to ensure that the nose is healing well. Recent follow-up studies by our team have shown that nasal function returns to normal about three to six months after surgery.

Join the Graves' Disease Support Group

Mass. Eye and Ear hosts a support group for patients and caregivers affected by Grave’s disease. This open forum is an opportunity for members to exchange information about the disease and to hear from doctors who are performing the latest treatments. Please contact us for meeting information: call 877-643-3123 or email eyelid@meei.harvard.edu.